18390 (2) ' : .POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 18390
r' INSPECTION DIVISION
JOB INSPECTIONr RECORD
Oa � N PBRT^EXe
ON
LOT# PIXES�FIWORK
JOB ADDRESS U/I T�#�,,, _
OWNER Poo L---_ .CONTRACTOR �Yr�/ �� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECrlON RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRACING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNkO �� Yf 17 h e t
UNDERGROUND /SLAB PAM
PLUMBING
ELECTRICAL JUL r� l I�a ll_ECT I OIG. V�
MECHANICAL' LOG ELEcr - PLG. MECH
{ Qf ❑ ❑ 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $SFT.
PLUMBING
MECHANICAL - Moo oo
`
ELECTRICAL - - PERMIT rO
FRAMING
INSULATION STORIES TVPE.corvsTR
OCC.GROUP .RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO FT FLOOR AREA TOTALACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID .
BULLDi USE
ROOF SHEATHING. Rts ido CON PB on...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 Q , 0 0 0
ROUGH SAN.q
ASSES SOHS PARCEL NO
'
PLUMBING /, ELECT.ENERGY
TUBS 8 SHOWER PAN Y PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT,FINAL TEST
ZONING ENC.SITE NO,
INSULATIONS PLUMBING ,Z
GASTEST GAS
FIRESPRINK ' ENERGY T'24
MECHANICAL
,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - FLOOD LONE.Y � NE ° "❑
' EXTERIOR SHEAR' ELECTRICAL RELEASE � � A.L.0 C
� N
. INTERIOR SHEAR,' FIRE DEPT. YE] YL No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH' S BUILDING Z -
INTERIOR LATH TEMPORARY APPROVALS BUILDING 4
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE 31%
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE,WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. IJ
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED.'LINES - USE BALL POINT PEN ONLY
BUILDING PR E TID NTIFICATIO
PERMITNUMBER
BUILDING APPLICATION & PERMIT
ADDRESS 83
90o0 4 ,LlIg-r0� 0
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL }
NAME
•a �- PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
717 `p I)
CONTRACTORS F•\6`-1
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 J
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS PPLIANCES-RESIDENTIAL 4.00
A
PHONE PANELS 10.00 DATE OF APPLICATION "
^ '
ARCHITECT PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO, SIGNS TRANS. .3.00
ARCH.ORENG. PERMIT VALIDATION
AODHESS ` SPECIALCIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00 n
ADDRESS lVfq 7OW 2>4 MOTORS SEE FEE SCH. o�A,��A,f�r
ADDRESS zOo�f ((ll /4 VC
(J f2%/iV0 L/.4' Fro/4 Fro/4SERVICE CHANGE _ 20.00
woo _ L CENSED CONTRACTORS DECLARATION -
Q L w I hereby affirm that I am licensed under provisions of Chapter 'ISSUANCE DATE
H (commencing with Section 7000)of Division 3 of the Business and
a u OG. ELECT. PLG. - MECH.
H H i Professions Code,and my license is in full force and effect J U L u Wtig
El El - El
D mff License Class I.ie.Number -
wr w Date - Contractor
¢ se f �011s UILDING PERMIT
¢ ¢ a OWNER.BUILDER DECLARATION
¢ Is u INFORMATION
'w ;u y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
._ o a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
r - Code:Any city or county which requires a permit to construct,alter,
� ELEC.CONTR. LIC.NO. 6
SE
SE a improve,demolish,or repair any structure,prior to its issuance,also ELEC.
usLD¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w H lie is licensed pursuant to the provisions of the Contractor's License
HZ >
Law(Chapter 9(cothmencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
ac = $ the basis for file alleged exemption.Any violation of Section 7031.5 _ STORIES TYPE CONSTR.
ui by any applicant for a permit subjects the applicant too civil penalty - ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,of my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'rhe Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees.provided that such improve-
mentsarenolintendedornffered employees,
or provided that such
building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS.-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did riot build or im- BUILDING USE
prove for purpose of sale.). I '• INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB other
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ '❑ ❑
licensed contractors to construct the project(Sec.7044,Business - LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractods)licensed pursuant to
the Contractor's License Law. . SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM -5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION- WATER TREATING EQUIP. 5.00
1 hereby affirm that I have u certificate ofconsmll to xelfinsure, E NO.
or a certificate of Workers'Compensation Inavanca,or a certified ZONING ENG.SITE
ropy thereof(Se<.3800,Lah.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T 24
ZZ D Certified copy is filed with the city inspection division.
MISC.- REFER TO ORD.
O Applicant V❑ N❑ Y C] N[]~ yLU
CERTIFICATE Or: IFROM WORKERS' PERMIT ISSUANCE 10.00
FLooD zoNE A.L.u.c.
W > COMPENSATION NSURANCi
PLG.CONTE, LIC.NO. PLG.
CL 0 (This section need noj he completed if the permit is for one ' TOTAL V❑ N❑ V ❑ No
hundred dollars(S 100)or less.)
00
1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I'sh all not employ any person in any manner so as to
O W become subject to the Workers Compensation Laws Of California. - BUILDING 00
y Date Applicant " ALTER OR ADD TO MECH. 5,00 •^
} to NOl'ICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK [ tom+
provisions of the Labor Code, you most forthwith comply with FEE �S
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /CO
I hereby affirm that their, is a construction funding agency for EXHAUST HOOD(WITH DUCT) 5.00
[he performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and stale that(lie above VENTILATION FAN (SINGLE) 4.00
information n carred.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to ly with
construction,dco SBII BOILER•COPo1P.13H.P.or100,0008.T.U.1 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOVe,100,0008TUISEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
- .upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
may in any way accrue against sand fly in consequence of the
•rantin lhbpennit. MECH.CONT.. LIC.NO. MECH.
r� /✓, r, G 7 ,�j TOTAL ` TOTAL �!
Signature of ApplicanDCoutractor Date
OFFICE COPY